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drug prescriptions: Therapeutic advances or fads?
could be advanced to explain this phenomenon: physicians'
lack of knowledge, the influence of the pharmaceutical
industry, patient demands or even a possible "fashion
factor" when new drugs are marketed. "While we cannot
exclude external factors when explaining the prescription
increase, we must also take into account the therapeutic
reasoning of physicians, who do not prescribe drugs solely
under the influence of external factors," Collin
treatment of depression today, Collin notes that about 80%
of antidepressants are prescribed by family physicians.
According to her, their process of reasoning is similar to
how their counterparts approached their patients in the
nineteenth century in that they mostly take into account
the situation of their patients, their difficulties, and
their specificity. "We are faced with a social phenomenon
in which people visit a doctor because they do not feel
well for all sorts of reasons, but it is not necessarily a
question of mental illness. The doctors then have a tool
before them that can often work, the antidepressant, which
has become a sort of panacea. This is another reason for
the prescription increase," says Collins.
"On the one
hand, there is constant
expansion of diagnostic categories in the DSM,
which aims to standardize diagnostic and therapeutic
practices, and on the other hand, we work with patients
whose life experiences are complex.
What doctors say is that the DSM does not correspond to real
are caught in the tension between wanting to consider
patients as specific individuals, to tailor treatments to
them, and the need for standardized practice," explains
Collin. "It seems that the desire for psychiatry based on
a kind of universalism is removed from the reality of
doctors and psychiatrists, who stress the need for a
comprehensive approach involving the bio-psycho-social
dimensions of the patient," she concludes.
Painkillers, Drug Addiction
Opioid painkiller addiction and accidental overdoses have become far too common across the United States. To try to identify who is most at risk, Mayo Clinic researchers studied how many patients prescribed an opioid painkiller for the first time progressed to long-term prescriptions. The answer: 1 in 4. People with histories of tobacco use and substance abuse were likeliest to use opioid painkillers long-term.
While the study identified past or present nicotine use and substance abuse as top risk factors for long-term use of opioids, all patients should proceed with caution when offered opioid painkiller prescriptions, says lead author W. Michael Hooten, M.D., an anesthesiologist at Mayo Clinic in Rochester.
"From a patient perspective, it is important to recognize the potential risks associated with these medications. I encourage use of alternative methods to manage pain, including non-opioid analgesics or other nonmedication approaches," Dr. Hooten says. "That reduces or even eliminates the risk of these medications transitioning to another problem that was never intended."
Long-term opioid use may actually make people more sensitive to pain - a condition called opioid-induced hyperalgesia, another recently published study by Dr. Hooten and other Mayo researchers found.
If opioids must
be used, as is usually the case with surgery or traumatic
injuries, reducing the dose and limiting the duration of
use is important, Dr. Hooten says.
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